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  1. Workload and workflow implications associated with the use of electronic clinical decision support tools used by health professionals in general practice: a scoping review
    Fletcher E, Burns A, Wiering B, Lavu D, Shephard E, Hamilton W, et al.
    BMC Prim Care, 2023 Jan 20;24(1):23.
    PMID: 36670354 DOI: 10.1186/s12875-023-01973-2
    BACKGROUND: Electronic clinical decision support tools (eCDS) are increasingly available to assist General Practitioners (GP) with the diagnosis and management of a range of health conditions. It is unclear whether the use of eCDS tools has an impact on GP workload. This scoping review aimed to identify the available evidence on the use of eCDS tools by health professionals in general practice in relation to their impact on workload and workflow.

    METHODS: A scoping review was carried out using the Arksey and O'Malley methodological framework. The search strategy was developed iteratively, with three main aspects: general practice/primary care contexts, risk assessment/decision support tools, and workload-related factors. Three databases were searched in 2019, and updated in 2021, covering articles published since 2009: Medline (Ovid), HMIC (Ovid) and Web of Science (TR). Double screening was completed by two reviewers, and data extracted from included articles were analysed.

    RESULTS: The search resulted in 5,594 references, leading to 95 full articles, referring to 87 studies, after screening. Of these, 36 studies were based in the USA, 21 in the UK and 11 in Australia. A further 18 originated from Canada or Europe, with the remaining studies conducted in New Zealand, South Africa and Malaysia. Studies examined the use of eCDS tools and reported some findings related to their impact on workload, including on consultation duration. Most studies were qualitative and exploratory in nature, reporting health professionals' subjective perceptions of consultation duration as opposed to objectively-measured time spent using tools or consultation durations. Other workload-related findings included impacts on cognitive workload, "workflow" and dialogue with patients, and clinicians' experience of "alert fatigue".

    CONCLUSIONS: The published literature on the impact of eCDS tools in general practice showed that limited efforts have focused on investigating the impact of such tools on workload and workflow. To gain an understanding of this area, further research, including quantitative measurement of consultation durations, would be useful to inform the future design and implementation of eCDS tools.

  2. Sailfish generate foraging opportunities for seabirds in multi-species predator aggregations
    Licht M, Burns AL, Pacher K, Krause S, Bartashevich P, Romanczuk P, et al.
    Biol Lett, 2024 Jul;20(7):20240177.
    PMID: 38982849 DOI: 10.1098/rsbl.2024.0177
    While various marine predators form associations, the most commonly studied are those between subsurface predators and seabirds, with gulls, shearwaters or terns frequently co-occurring with dolphins, billfish or tuna. However, the mechanisms underlying these associations remain poorly understood. Three hypotheses have been proposed to explain the prevalence of these associations: (1) subsurface predators herd prey to the surface and make prey accessible to birds, (2) subsurface predators damage prey close to the surface and thereby provide food scraps to birds, and (3) attacks of underwater predators lower the cohesion of prey groups and thereby their collective defences making the prey easier to be captured by birds. Using drone footage, we investigated the interaction between Indo-Pacific sailfish (Istiophorus platypterus) and terns (Onychoprion sp.) preying on schooling fish off the eastern coast of the Malaysian peninsula. Through spatio-temporal analysis of the hunting behaviour of the two predatory species and direct measures of prey cohesion we showed that terns attacked when school cohesion was low, and that this decrease in cohesion was frequently caused by sailfish attacks. Therefore, we propose that sailfish created a by-product benefit for the bird species, lending support to the hypothesis that lowering cohesion can facilitate associations between subsurface predators and seabirds.
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